Introduction
Study purpose and conceptual framework
Current evidence on SDoH (related to CVD and opioid use mortality)
Gaps in the SDoH literature (related to CVD and opioid use mortality)
Study objectives
Methodology
Data sources
Limitations of the US AHRQ SDoH framework and database
Criteria for exclusion of independent (SDoH) variables from the study
Variable name | Variable label | Counties covered | Mean | S.D | Min | Max | N |
---|---|---|---|---|---|---|---|
Dependent variables (outcome measures) | |||||||
CDC_HEART_DISEASE_DEATH | Total cardiovascular disease (CVD) death rate per 100,000 population per year | 3,152 | 250.7306 | 59.64733 | 56.7 | 645.6 | 31,017 |
CDC_OPIOID_DEATH | Total drug overdose death rate involving any opioid per 100,000 population per year | 554 | 17.82371 | 15.24973 | 0.03 | 157.57 | 3,273 |
Independent (SDoH) variables: Socio-economic context | |||||||
ACS_PCT_FEMALE | Percentage of population that is female | 3,226 | 50.03082 | 2.420218 | 19.16 | 62.64 | 32,208 |
ACS_MEDIAN_AGE | Median Age | 3,226 | 40.46141 | 5.203414 | 18 | 67 | 32,208 |
ACS_PCT_BLACK | Percentage of population reporting Black race | 3,223 | 8.940934 | 14.40663 | 0 | 87.412 | 32,205 |
ACS_PCT_WHITE | Percentage of population reporting White race | 3,223 | 83.3241 | 16.78994 | 3.11 | 100 | 32,205 |
ACS_PCT_HISPAN | Percentage of population reporting Hispanic ethnicity | 3,223 | 83.3241 | 19.15072 | 0 | 100 | 32,205 |
ACS_PCT_ASIAN | Percentage of population reporting Asian race | 3,223 | 1.205131 | 2.624424 | 0 | 52.228 | 32,205 |
ACS_PCT_BACHELOR_DGR | Percentage of population with a bachelor's degree (ages 25 and over) | 3,223 | 13.1801 | 5.419684 | 1.679 | 47.985 | 32,205 |
ACS_MEDIAN_HH_INCOME | Median household income | 3,223 | 46,030.93 | 13,128.92 | 10,499 | 136,268 | 32,203 |
ACS_PCT_PERSON_INC99 | Percentage of population with income to poverty ratio: < 1.00 | 3,223 | 16.9234 | 8.297911 | 0 | 65.715 | 32,204 |
ACS_PCT_UNEMPLOY | Percentage of population that was unemployed (ages 16 years and over) | 3,223 | 4.737517 | 2.302576 | 0 | 30.132 | 32,204 |
ACS_PCT_GRP_QRT | Percentage of persons in institutionalized (correctional) group quarters | 3,223 | 3.480389 | 4.601596 | 0 | 80.178 | 32,205 |
ACS_PCT_VA | Percentage of the civilian population consisting of veterans (ages 18 and over) | 3,223 | 10.18986 | 3.068378 | 0 | 32.399 | 32,205 |
ACS_PCT_ARMED_FORCES | Percentage of civilian population in armed forces (ages 16 years and over) | 3,223 | 0.322018 | 1.661381 | 0 | 81.247 | 32,204 |
Independent (SDoH) variables: Healthcare context | |||||||
AHRF_FED_HLTH_CNT | Number of Federally Qualified Health Centers | 3,226 | 1.972197 | 5.914462 | 0 | 241 | 32,227 |
AHRF_RURAL_H_CLINIC | Number of rural health clinics | 3,226 | 1.255283 | 2.035866 | 0 | 44 | 32,227 |
Independent (SDoH) variables: Physical infrastructure context | |||||||
ACS_TOTAL_HOUSEHOLD | Total number of households | 3,223 | 36,457.85 | 110,690.9 | 22 | 3,306,109 | 32,205 |
ACS_PCT_RENTED_HH | Percentage of occupied housing units: rented | 3,223 | 27.87347 | 8.065046 | 5.275 | 100 | 32,205 |
ACS_PCT_MOBILE_HOME | Percentage of housing units that are mobile homes | 3,223 | 12.78241 | 9.492498 | 0 | 63.485 | 32,205 |
Dependent and independent (SDoH) variables included in the study
Descriptive statistics for objectives 1 & 2
Empirical approach for objectives 3 and 4
Results
Descriptive results for objectives 1 & 2
Empirical results for objectives 3 & 4
Coefficient | Robust Standard Error | Coefficient | Robust Standard Error | |
---|---|---|---|---|
(1) | (2) | |||
Socio-economic context | ||||
ACS_PCT_FEMALE | 0.3409742 | 0.4329923 | 0.3979829 | 0.4319126 |
ACS_MEDIAN_AGE | 1.536069*** | 0.3724445 | 0.9442199** | 0.4001888 |
ACS_PCT_BLACK | -0.0107354 | 0.2413531 | 0.1794991 | 0.2397232 |
ACS_PCT_WHITE | -0.0717861 | 0.1247179 | -0.2094997* | 0.1254058 |
ACS_PCT_HISPAN | 0.2419456 | 0.4314109 | 0.0770919 | 0.461046 |
ACS_PCT_ASIAN | -0.1054069 | 0.7548355 | 0.3603354 | 0.7752729 |
ACS_PCT_BACHELOR_DGR | -0.3156336 | 0.2645122 | -0.2792628 | 0.263056 |
ACS_MEDIAN_HH_INCOME | -0.0000478 | 0.000145 | -0.0002255 | 0.0001522 |
ACS_PCT_PERSON_INC99 | -0.1662807 | 0.1749954 | -0.1712101 | 0.1814317 |
ACS_PCT_UNEMPLOY | -0.0497029 | 0.2940154 | 0.0870857 | 0.3142549 |
ACS_PCT_GRP_QRT | 0.339881 | 0.2730854 | 0.3501566 | 0.2665062 |
ACS_PCT_VA | -0.4632768 | 0.3455583 | -0.1184386 | 0.3484473 |
ACS_PCT_ARMED_FORCES | 1.62571*** | 0.4766393 | 1.298195*** | 0.4737176 |
Healthcare context | ||||
AHRF_FED_HLTH_CNT | -0.1742908** | 0.0752576 | -0.023582 | 0.0711803 |
AHRF_RURAL_H_CLINIC | -0.4186592 | 0.4115517 | -0.5452554 | 0.4158551 |
Physical infrastructure context | ||||
ACS_TOTAL_HOUSEHOLD | 0.0000378 | 0.0000815 | -0.0000278 | 0.0000833 |
ACS_PCT_RENTED_HH | 0.1158973 | 0.1644035 | 0.15963 | 0.1651907 |
ACS_PCT_MOBILE_HOME | -0.0127164 | 0.2073848 | 0.0083726 | 0.2116054 |
County Fixed Effects | Yes | Yes | ||
Year Fixed Effects | Yes | Yes | ||
State-by-Year Fixed Effects | No | Yes |
Mean | S.D | Coefficient value (estimated effect on CVD death rate per 100,000) | Percent change in mean of DV based on coefficient valuea | Effect size per 100,000b | Percent change in mean of DV based on effect sizec | |
---|---|---|---|---|---|---|
Mean of Dependent Variable (CVD Death Rate) in the sample is 250.73 per 100,000 | ||||||
COUNTY & YEAR EFFECTS | ||||||
ACS_MEDIAN_AGE | 40.46141 | 5.203414 | 1.536069 | 0.6126% | 7.99280294 | 3.18781% |
ACS_PCT_ARMED_FORCES | 0.322018 | 1.661381 | 1.62571 | 0.6484% | 2.700923706 | 1.07722% |
AHRF_FED_HLTH_CNT | 1.972197 | 5.914462 | -0.1742908 | -0.0695% | -1.030836314 | -0.41113% |
COUNTY, YEAR, & STATE-BY-YEAR FIXED EFFECTS | ||||||
ACS_MEDIAN_AGE | 40.46141 | 5.203414 | 0.9442199 | 0.3766% | 4.913167047 | 1.95954% |
ACS_PCT_WHITE | 83.3241 | 16.78994 | -0.2094997 | -0.0836% | -3.517487393 | -1.40290% |
ACS_PCT_ARMED_FORCES | 0.322018 | 1.661381 | 1.298195 | 0.5178% | 2.156796507 | 0.86021% |
Coefficient | Robust Standard Error | Coefficient | Robust Standard Error | |
---|---|---|---|---|
(1) | (2) | |||
Socio-economic context | ||||
ACS_PCT_FEMALE | -2.97943* | 1.520326 | -0.1038778 | 1.38789 |
ACS_MEDIAN_AGE | -1.561816 | 1.06467 | -1.818271** | 0.9173134 |
ACS_PCT_BLACK | -0.0260737 | 0.6232132 | -0.8427783 | 0.6334552 |
ACS_PCT_WHITE | -0.0427271 | 0.1831953 | 0.0736518 | 0.1366791 |
ACS_PCT_HISPAN | -0.8499315 | 0.547428 | -0.7622937* | 0.4591811 |
ACS_PCT_ASIAN | -0.7129578 | 0.7763505 | -0.3583486 | 0.700493 |
ACS_PCT_BACHELOR_DGR | 0.828501 | 0.7093535 | -0.0352932 | 0.6007481 |
ACS_MEDIAN_HH_INCOME | -0.0002196 | 0.0002075 | -0.0002722* | 0.0001616 |
ACS_PCT_PERSON_INC99 | 0.9581279*** | 0.3668685 | 0.3505055 | 0.3763996 |
ACS_PCT_UNEMPLOY | 0.2896208 | 0.4403138 | -1.001564 | 0.6353915 |
ACS_PCT_GRP_QRT | 0.2479495 | 1.175182 | 0.3511598 | 0.9632748 |
ACS_PCT_VA | -1.593724* | 0.8986767 | -1.352879* | 0.8021658 |
ACS_PCT_ARMED_FORCES | 1.086618 | 0.6898298 | -0.6789627 | 0.4940171 |
Healthcare context | ||||
AHRF_FED_HLTH_CNT | 0.0510922 | 0.0335136 | 0.0419603 | 0.0328061 |
AHRF_RURAL_H_CLINIC | -0.0076559 | 0.3444708 | 0.3126213 | 0.226519 |
Physical infrastructure context | ||||
ACS_TOTAL_HOUSEHOLD | 0.0000531 | 0.0000475 | 0.0000125 | 0.0000367 |
ACS_PCT_RENTED_HH | -0.1175498 | 0.3768721 | -0.2319311 | 0.3980847 |
ACS_PCT_MOBILE_HOME | 1.157881* | 0.5888022 | 0.9330352 | 0.6705346 |
County Fixed Effects | Yes | Yes | ||
Year Fixed Effects | Yes | Yes | ||
State-by-Year Fixed Effects | No | Yes |
Mean | S.D | Coefficient value (estimated effect on opioid use death rate per 100,000) | Percent change in mean of DV based on coefficient valuea | Effect size per 100,000b | Percent change in mean of DV based on effect sizec | |
---|---|---|---|---|---|---|
Mean of Dependent Variable (Opioid Use Death Rate) in the sample is 17.82 per 100,000 | ||||||
COUNTY & YEAR EFFECTS | ||||||
ACS_PCT_FEMALE | 50.03082 | 2.420218 | -2.97943 | -16.7196% | -7.210870116 | -40.46504% |
ACS_PCT_PERSON_INC99 | 16.9234 | 8.297911 | 0.9581279 | 5.3767% | 7.950460041 | 44.61538% |
ACS_PCT_VA | 10.18986 | 3.068378 | -1.593724 | -8.9435% | -4.89014766 | -27.44191% |
ACS_PCT_MOBILE_HOME | 12.78241 | 9.492498 | 1.157881 | 6.4976% | 10.99118308 | 61.67892% |
COUNTY, YEAR, & STATE-BY-YEAR FIXED EFFECTS | ||||||
ACS_MEDIAN_AGE | 40.46141 | 5.203414 | -1.818271 | -10.2035% | -9.461216777 | -53.09325% |
ACS_PCT_HISPAN | 83.3241 | 19.15072 | -0.7622937 | -4.2777% | -14.59847321 | -81.92185% |
ACS_MEDIAN_HH_INCOME | 46,030.93 | 13,128.92 | -0.0002722 | -0.0015% | -3.573692024 | -20.05439% |
ACS_PCT_VA | 10.18986 | 3.068378 | -1.352879 | -7.5919% | -4.15114416 | -23.29486% |